the status of phssr in the united states...rwj/cdc national phssr research agenda setting •several...
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The Status of PHSSR in the United States
May 26, 2011PHSSR THINK TANK Montreal Canada
F. Douglas Scutchfield, MDPeter P. Bosomworth Professorship of Health Services
Research and Policy and DirectorUniversity of Kentucky
National Coordinating Center for Public Health Systems & Services Research
What is PHSSR?
A field of inquiry examining the organization, financing, and delivery of public health services at local, state and national levels, and the impactof these activities on population health.
Mays, G. P., Halverson, P. K., & Scutchfield, F. D. (2003). Behind the curve? What we know and need to learn from public health systems research. J Public Health Management and Practice, 9(3), 179-182.
Macro context
Social, Political, Economic forces operating in the overall society (e.g. National economy)
Extent of Demand and need for public health services within the population
Social values and preferences for products of public health systems (e.g. clean water)
External forces such as: Medical delivery systems, Technological advances, Nature of federal-state-local relationships
Local Public
Health System
PHS Mission and Purpose
Goals and how they are to be implemented
Performance of the core functions of assessment, policy development,
and assurance
Capacity
System Inputs:
Workforce
Facilities
Technology
Organizational
relationships
Funding
Processes
Essential
Public
Health
Services
Outputs
Programs
and Services
consistent
with
mandates
and
community
priorities
Process Outcomes
Improved
organizational
performance
Improved program
performance
Community Health
Outcomes
Improved Health
Practices, Environment,
Life Styles
Improved Morbidity and
Mortality Rates
Improved Health Status
Early Steps In Establishing PHSSR•Data
–HSRR Listing , Bibliographic citations–Data Harmonization
•Researchers–Mini-grants
•Venues and opportunities for net working–Keeneland Conference–AcademyHealth PHSR Special Interest Group
•Funding for research–RWJ/NNPHI
•Linkage of practice to research and translation–PBRNs–Communication/website/Social networking
Developmental Path for PHSSR
Descriptive
Inferential
Translational
Measuring practice & performance
Detecting variation in practice
Examining determinants of variation
– Organization – Law & policy
– Financing – Information
– Workforce – Preference
Determining consequences of variation
– Health outcomes – Medical care use
– Economic outcomes – Disparities
Testing strategies to reduce harmful,
unnecessary, & inequitable variation
in practice and outcomes
Key Literature in PHSSR in the US
Mays, G. P., Halverson, P. K., & Scutchfield, F. D. (2003). Behind the curve? What we know and need to learn from public health systems research. J Public Health Management and Practice, 9(3), 179-182.
• Argues for a renewed focus on how the public health system interacts with the contextual factors that influence health
Key Literature in PHSSR in the US
Mays, G. P., McHugh, M. C., Shim, K., Perry, N., Lenaway, D., Halverson, P. K., et al. (2006). Institutional and economic determinants of public health system performance. [Article]. American Journal of Public Health, 96(3), 523-531.
Scutchfield, F. D., Knight, E. A., Kelly, A. V., Bhandari, M. W., & Vasilescu, I. P. (2004). Local public health agency capacity and its relationship to public health system performance. J Public Health Management and Practice, 10(3), 204-215.
• Both examine impact of variation in both financial and agency capacity variables on system performance
Key Literature in PHSSR in the US
Scutchfield, F. D., Marks, J. S., Perez, D. J., & Mays, G. P. (2007). Public health services and systems research. American Journal of Preventive Medicine, 33(2), 169-171
• Calls for renewed emphasis on developing and adapting research methods/techniques suitable for examining the public health system
RWJ/CDC National PHSSR Research Agenda Setting
• Several PHSSR research agendas exist– Out of date and/or too specific
• Broad process involving as many constituents as possible
• Started in Fall 2010• The Atlanta Ice Storm of January 2011• Webinars on topical areas• Projected Conclusion in September 2011• Still in Process• Available on the Publichealthsystems.org website mid
June
Setting the PHSSR Agenda
Step One: Comprehensive systematic literature review, including targeted reviews in four areas:
– Public health workforce
– Organization/structure
– Technology/data methods
– Quality improvement
Setting the PHSSR Agenda
Step Two: White papers distributed to key practice and research partners
– Systematic literature reviews, contained key findings of those reviews, and unexamined areas of critical research
– Through review of RWJ funded research literature of PHSSR research through early 2010
Setting the PHSSR Agenda
Step Three: Webinars with subject matter experts in the four areas covered by the targeted systematic reviewsWorkforceFinanceData and MethodsStructure and Organization– Facilitated discussions to develop and then discuss key
areas of research/research questions that have utility to the practice community
Setting the PHSSR Agenda
Step Four: Vetting with research and practice community: Keeneland Conference, AcademyHealth PHSR IG, NACCHO annual meeting etc. (ongoing)
– Submit input from larger group of public health researchers and practitioners
Setting the PHSSR Agenda
Step Five: Online comment period (pending)
– Will be available on key organizations intranet, as well as internet for community at large www.publichealthsystems.org
– Give entire PHSSR/public health community opportunity to comment on/shape research agenda
– Social media
Setting the PHSSR Agenda
Step Six: Publication (pending)
– Widespread dissemination; AJPM supplement
– Use of the web and social media resources
– Utility and value to PHSSR researchers
– Sets the stage for funding of research and development of research resources
Setting the PHSSR Agenda
Step Seven: Back to step one (constant)
– Research agenda should be forward thinking, trying to advance the field
– In order for research agenda to be relevant, it must reflect the state of the art in research
– Becomes quickly outdated
– Needs to evolve
National Coordinating Center for PHSSR
• RWJF Funded Coordinating center for PHSSR work
• Awarded Competitively to UK
•Five Pillars
–Education of Researchers ($1M)
–Education of Practitioners to use research ($1M)
–Increased base of Funding for Research ($1.5M)
–Increased current grant funding for research ($2.4M and $2.5M)
–Technical Assistance, communication, dissemination, utilization and visibility of PHSSR($3.4M)
NCC Charge • To create a unified, coherent agenda for PHSSR
• To synthesize, translate and disseminate results of current and past investments in PHSSR by RWJF and other funders
• To increase the number of researchers in the field with the appropriate skills to conduct quality work
• To strengthen the ability of practitioners to interpret and apply PHSSR findings
• To increase the relevance of PHSSR findings to practitioners
• To increase the number of practitioners who are engaged in PHSSR
• To increase the number of policy-makers who are aware of PHSSR
• To increase the number of funders committed to PHSSR
• To inform public health policy and practice, which will lead to better health outcomes for all Americans
What have we learned• Funding is key, Willie Sutton principle applies
in the academy, if you fund it they will come
• Transitioning a researcher from an existing comfortable research area to a new one is hard, it is easier to grow new ones
• With practitioners, if you build it they won’t come, you have to go to them
• Things that work in HSR in general also work in PHSSR, like typology, QI, accreditation
What have we learned• Questions from practice are always more interesting• With many players and organizations in PH,
coordination is herding cats• We don’t get no respect and what we do is hard to
explain• We need new data, particularly financial data and
longitudinal data• How do we get interest from Feds other than CDC, like
NIH’s CTSA and AHRQ Comparative Effectiveness and HIT work
• We need to use new and more robust methodology for our efforts
That’s All FolksQuestions?
For more information contact:F. Douglas Scutchfield
121 Washington Avenue, Suite 212Lexington, KY 40517
859-257-5678 www.publichealthsystems.org